Initial Workup Hallux Limitus for potential surgery

This wonderful young lady (my age) presented to the office to discuss surgery on her big toe joints. She has a bone spur on the top of the joint that is painful to wear shoes (especially non athletic). A surgeon had recommended removing the bone spur in a relatively simple procedure by shaving the top of her joint. Where this may be perfect, I have had too many patients that have problems when the joint itself is damaged. Removing the spurs from the top of the foot removes bump pain, but can increase bending pain. The shaving procedures typically cause scarring of the ligaments on top of the joint permanently limited the range of motion further. It is rare that patients get more range of motion after surgery, typically less, so jamming of the joint with bending can occur easier. 

Here are the x rays that she brought into the first visit. We are now going to get MRIs to look at the internal nature of the joints and see if they are damaged. Can you guess what joint has more damage and what joint has less range of motion because of that fact from looking at these photos? First 3 are the left side, and the second 3 are the right side.

It is the left side that is worse in range of motion and pain, but the x rays really can not say that for sure. There are suggestions that both joint surfaces will have too much damage (osteoarthritis) to qualify for this bone shaving. The decision may be to implant or fuse. I prefer to implant these joints, since there is no going back once it is fused. The patient has over 40 degrees of range of motion now on the left and 55 degrees on the right.